Provider Demographics
NPI:1700183266
Name:FONGWITOO, ANNA JANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JANE
Last Name:FONGWITOO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 LAWTON TRL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2848
Mailing Address - Country:US
Mailing Address - Phone:901-347-3243
Mailing Address - Fax:
Practice Address - Street 1:1625 LAWTON TRL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2848
Practice Address - Country:US
Practice Address - Phone:901-347-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist